WARFARIN / ASPIRIN RESEARCH
In November 2007 Dr. Dixon published his study on the effect that warfarin and aspirin management has on complications following skin cancer surgery. This study, by far the largest of its type ever undertaken, was published in the “British journal of Surgery”.
Dr. Dixon has shown that Aspirin need never be ceased for skin surgery but on unusual occasions only warfarin could be considered for temporary cessation.
Dr. Dixon completed and published a prospective study of patient perceptions of their skin cancer surgery in the “Journal of the American Academy of Dermatology” in September 2007.
This study helps dispel the myth that patients most concerned about scar outcomes are young females having surgery to the face. None of these features were demonstrated to be a risk factor for poor scar perception. All age groups are equally concerned about scar appearance. Further, patients are least happy about their scars when they have had skin surgery to their trunk.
Females and males were equally concerned about their scars and scar appearance was the most important aspect in determining the patient’s overall perception of their service. Dr. Dixon has also contributed to other research published in this journal.
For years doctors have put ointment on wounds after suturing them closed. Other doctors have placed Vaseline impregnated gauze on such wounds. Up until now there has been no research on such practice.
In August 2006 Associate Prof. Dixon published the first ever random control trial of the value of placing ointments on sutured wounds after excision and closure of skin lesions prior to dressing.
He compared an antibiotic ointment, (Bactroban), with sterile wax (Lacrilube) and no ointment at all.
This research demonstrated that ointment has no value prior to dressing on a closed surgical wound. This research was also published in the “British Journal of Surgery”.
Dr. Dixon further cautioned that usage of the antibiotic may lead to antimicrobial resistance and may have a chemical effect on the wound edge that impedes healing.
This practice of placing ointments including antibiotic ointments on clean sutured wounds has now been debunked.
SMOKING AND SKIN CANCER
In September 2008 Dr. Dixon published the world's largest trial on the outcomes of smokers versus non smokers having skin surgery. Dr. Dixon and all of his research team are non smokers. Indeed they dislike smoking, especially when eating at restaurants and at public venues. Certainly they prohibit smoking in their own homes. It has been said that smokers get more complications following skin surgery. Dr. Dixon expected this to be the case. However this large prospective study did not find any difference in outcomes of any note.
This research once again demonstrated that what we think we are seeing happening with our patients may not be happening after all.
ROM FLAP RESEARCH
From 2000 until 2003 Associate Prof. Dixon developed a new skin flap repair designed for closing defects in the skin following removal of lesions below the knee. He called this new reconstruction the “reducing opposed multilobed (ROM) flap”. It was designed from first principles recognizing the issues that have made skin flaps on the leg so difficult and fraught with failure.
The ROM flap was introduced to the world in the November 2004 edition of "Dermatologic Surgery".
Dr. Dixon then trialed the ROM flap, confirming the theoretical benefits translated into real improvements for patients. This trial was published in the July 2006 edition of "Dermatologic Surgery".
This technique is now regarded as the benchmark technique for closing defects between 11 and 45 mm in diameter below the knee. The ROM flap is being used widely throughout Australia and the USA as well as Europe.
Many Australian rural doctors are now using the ROM flap. Rural doctors who wish to contribute to the pool of ROM flaps in rural practice can log their surgery on the Health Workforce Queensland ROM flap cases database.
Despite infection being the commonest complication of skin cancer surgery, - little is known about the circumstances and risk factors for skin surgery infection.
From 2001 until 2005 Associate Prof. Dixon implemented the world’s largest prospective study of the risk factors for skin infection with skin cancer surgery. This research was published in “Dermatologic Surgery” in June 2006. The detail and depth of the manuscript was commended by the journal’s co-editor. For the first time we now have evidence that below the knee is the site of greatest wound infection following skin surgery. All other sites are relatively low risk.
In fact Associate Prof. Dixon’s work on Complications in skin surgery extends beyond just infection and bleeding. He has the largest trials and data on all aspects of skin cancer surgery complications and further work in this area is pending publication.
In April 2008 Dr. Dixon published an original research piece in the "Journal of Plastic Reconstructive and Aesthetic Surgery". This study focued on parts of the body from the bleeding complication point of view. Dr. Dixon identified that surgery on or near the ear resulted in the highest risk of post operative bleeding complications of any skin surgery.
WELDING & SKIN CANCER RESEARCH
While ultraviolet from the sun is by far the commonest cause of skin cancer, there are other sources of ultraviolet including arc welding. Associate Prof. Dixon has studied this further risk factor for skin cancer and this has been published in the Medical Journal of Australia as an alert to the medical community.
23 GOLDEN RULES
As part of Dr. Dixon’s commitment to educating the Medical Profession, he developed a set of Golden Rules designed to help General Practitioners avoid pitfalls when managing skin cancer. These were fine tuned in conjunction with a USA dermatologist expert in the field. These rules have been published and now guide GPs throughout Australia in methods to improve the management of skin cancer. The 23 Golden Rules were updated in 2008. The newer version can be seen in full here.
SENTINEL NODE ANALYSIS
In managing malignant melanoma, a test known as the sentinel node biopsy has been developed as an idea that might prolong survival in melanoma patients. Dr. Dixon was asked to review the research on sentinel node biopsy for a British dermatology journal. His summary of the role, (more the lack of role) of this test has been published in the journal in 2006.
In May 2008 Dr. Dixon wrote a short analysis of sentinel node bippsy in the British Medical Journal. The full text of this piece is available here.
SKIN CANCER IN GENERAL PRACTICE RESEARCH
In Australia we have seen an emergence of “skin cancer clinics” in primary care. Dr. Dixon has studied the emergence of these clinics in conjunction with academics at the University of Queensland. It has been identified that education and standards are needed to ensure the public receive a quality service. Dr. Dixon will continue to contribute to the further education needs of Australian doctors.
SKIN CANCER SERIES
The journal of the Royal Australian College of General Practitioners has invited Associate Prof. Dixon to contribute a series on skin cancer management for the further education of Australian GPs. This series included contributions to thirteen consecutive issues of the journal. To find out more about this Skin Cancer Series, The first was published in the July 2006 edition of this the leading journal for GPs in Australia. The final contribution was in August 2007.
List of Dr. Dixons Publications